MEDICARE: DR. JACLYN J RAMIREZ DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00289500	NJ

General Provider Information

NPI Number	:	1952446163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN J RAMIREZ DPM

Provider Business Mailing Address
First Line	:	1401 VAN HOUTEN AVE APT C7
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 HAMBURG TPKE STE 108
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2033
Country	:	US
Telephone Number	:	973-925-4111
Fax Number	:	973-925-7711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/13/2019

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